<include file="Public:header" />
<!-- ppt -->
	<div class="floor">
		<div id="slider_container">
			<div id="index_slider" >
				<ul>
					<li><a href=""><img src="/Public/home/default/image/slider_1.jpg" width="990" height="340" alt=" " /></a></li>
					<li><a href=""><img src="/Public/home/default/image/slider_2.jpg" width="990" height="340" alt=" " /></a></li>
					<li><a href=""><img src="/Public/home/default/image/slider_3.jpg" width="990" height="340" alt=" " /></a></li>
				</ul>
			</div>
		</div>
	</div>
	<div class="clear"></div>
<include file="Public:sub_nav" />
<!-- center -->
	<div class="floor intro_center">
	<include file="Public:sub_nav_left" />	
		<div class="center_right">
			<div class="sub_right_title"><span>借款登记</span></div>
			<div class="data_from" >
				<span class="warning">注: 以下内容应如实填写, 以便我们与您联系. 同时我们将对您的资料严格保密! 谢谢合作!</span>
				<form name="" target="iframe1">
				<table class="data_table">
					<tr>
						<td class="td_right">借款人姓名 :</td>
						<td><input type="text" name="" id="" class="t_input" /></td><td><span>先生/女士 请正确填写您的姓名,方便我们与您联系.</span></td>
					</tr>
					<tr>
						<td class="td_right">借款数额 :</td>
						<td><input type="text" name="" id="" class="t_input" /></td>
						<td>万元<span class="red"> * 必填</span></td>
					</tr>
					<tr>
						<td class="td_right">借款目的 :</td>
						<td><input type="text" name="" id="" class="t_input" /></td>
						<td><span class="red"> * 必填</span></td>
					</tr>
					<tr>
						<td class="td_right">还款方式 :</td>
						<td><input type="text" name="" id="" class="t_input" /></td>
						<td><span class="red"> * 必填</span></td>
					</tr>
					<tr>
						<td class="td_right">愿付利息(年息) :</td>
						<td><input type="text" name="" id="" class="t_input" /></td>
						<td>%<span class="red"> * 必填</span></td>
					</tr>
					<tr>
						<td class="td_right">借款期限 :</td>
						<td><input type="text" name="" id="" class="t_input" /></td>
						<td>个月<span class="red"> * 必填</span></td>
					</tr>
					<tr>
						<td class="td_right">抵押物省份 :</td>
						<td><select name="province" id="province" onchange="getList(this.value,'city',1)">
								<option value="-1" selected="selected">请选择</option>
							</select>
						</td>
						<td></td>
					</tr>
					<tr>
						<td class="td_right">抵押物城市 :</td>
						<td><input type="text" name="" id="" class="t_input" /></td>
						<td></td>
					</tr>
					<tr>
						<td class="td_right">抵押物面积 :</td>
						<td><input type="text" name="" id="" class="t_input" /></td>
						<td></td>
					</tr>
					<tr>
						<td class="td_right">抵押物位置 :</td>
						<td><input type="text" name="" id="" class="t_input" /></td>
						<td></td>
					</tr>
					<tr>
						<td class="td_right">联系电话 :</td>
						<td><input type="text" name="" id="" class="t_input" /></td>
						<td></td>
					</tr>
					<tr>
						<td class="td_right">备注信息 :</td>
						<td colspan="2" ><textarea rows="6" cols="70"></textarea></td>
					</tr>
					<tr>
						<td class="td_right">验证码 :</td>
						<td colspan="2">
							<input type="text" name="" id="" class="code" />&nbsp;&nbsp;<img src="" width="90" height="35" id="" />
						</td>
					</tr>
					<tr><td></td><td></td><td></td></tr>
					<tr>
						<td></td>
						<td colspan="2">
							<input type="button" name="" id="" value="提交" class="btn" />&nbsp;&nbsp;&nbsp;&nbsp;
							<input type="reset" value="重置" class="btn" />
						</td>
					</tr>
				</table>
				</form>
			</div>
		</div>
		
	</div>
	<div class="clear"></div>
<include file="Public:footer" />